Association of Depression, Anxiety, and Somatic Symptom With Refractory Constipation

BACKGROUND: Chronic constipation (CC) is a prevalent clinical complaint with a subset of patients showing ineffective responses to conventional treatment. Considering the association between CC and psychological disorders, we investigated the correlation between anxiety, depression, and somatic symptoms with refractory constipation. METHOD: This retrospective study included 610 patients. The clinical characteristics, including somatic symptom (PHQ-15), depression (PHQ-9), anxiety (GAD-7), quality of life (PAC-QOL), constipation (KESS), demographic variables, anatomical abnormalities, and symptoms were investigated. Then we analyzed the general characteristics, compared the distribution of anxiety, depression, and somatic symptom, compared the clinical parameters of refractory and non-refractory constipation groups, conducted subgroup analysis, correlation analysis, and logistic regression to determine the independent related factors of somatic symptom. RESULTS: Demographic analysis identified that 36.0% of patients were refractory constipation (p < 0.001), and no significant differences in psychological disorders' distribution across CC subtypes. Subgroup analysis affirmed consistent findings across diverse categories. Correlation analysis revealed significant associations between psychological disorders and both KESS and PAC-QOL scores within both treatment groups (p < 0.05). Logistic regression analysis highlighted mild and severe GAD-7, severe PHQ-9, and PHQ-15 as independent risk factors for refractory constipation. The constructed model demonstrated a significant predictive value with an AUC of 0.81. CONCLUSION: This study identified anxiety, depression, and somatic symptom as independent risk factors for refractory constipation and underscored the strong association of psychological disorders with symptoms and distress irrespective of treatment outcomes. The integration of mental disorder assessment and consideration within therapeutic strategies might promote more targeted and effective interventions for CC patients.